Injuries Sending Incarcerated Adults to the ER: Assault and Self-Harm Five Times as Common

The report's visual summary. CDC, MMWR.

In brief

• Incarcerated adults suffer more poor health outcomes than adults generally, including unintentional and violence-related injuries.
• Among their nonfatal injury emergency department (ED) visits, the share caused by assault or self-harm was about five times that among other adults.
• Men and those under 65 had the highest share of assault-related visits; falls caused the most visits among those 65 and older; incarcerated women more often came for overdose or poisoning than men.
• Injury prevention tailored by age and sex could reduce injuries and ED visits in jails and prisons.

Background

From 2010 to 2019, U.S. state and federal prisons held 1.4–1.6 million people a year, and 10.3–12.9 million were admitted to local jails each year. No national study had looked at their injury-related ED visits; a study in a Seattle jail had found a high rate. CDC used the National Electronic Injury Surveillance System–All Injury Program (NEISS-AIP), a national sample of hospital EDs, and counted as incarcerated any adult brought to an ED from a jail or prison with an injury, identified from the case narratives.

What they found

About 733,547 ED visits by incarcerated adults, and 211,497,918 by other adults, were estimated for 2010–2019.

Among other adults, the most common cause was "other" mechanisms such as transportation injuries and drowning (41.0%).

By age. Compared with incarcerated adults 65 and older, those 18–24 more often came in after being struck or cut or pierced, or for assault or self-harm, less often after a fall, and were less often hospitalized. Older adults are the fastest-growing part of prison populations, and they had more visits for unintentional injuries, including falls, and more hospitalizations.

By sex. Incarcerated women came in less often after being struck and more often for falls and overdose or poisoning; 20.0% of their visits were for assault, against 37.4% for men.

What it means

This is the first national estimate of nonfatal injury ED visits by incarcerated adults. About 50,000 assaults in public correctional facilities are reported each year, and in 2019 adults held in jails were twice as likely to die by suicide as U.S. adults overall. The high share of assault and self-harm visits, especially among young men, points to violence and suicide prevention that takes the conditions of incarceration into account. Mental health services and protective environments in communities and facilities could help, and CDC's evidence-based resources on preventing suicide, violence, overdose and falls could be adapted for jails and prisons, by age and sex.

Limitations: some facilities treat injuries on site, and authorities, not patients, decide who goes to the ED, which may skew visits toward serious injuries; how close participating hospitals are to prisons may affect the estimates; incarceration was identified from narratives and may be misclassified; some injuries may have happened before incarceration; and race and ethnicity data were incomplete — though Justice Department statistics show Black men are disproportionately incarcerated, as a result of upstream factors including structural racism, and so are likely overrepresented here. Nearly one in every 100 people in the U.S. is in a prison or jail.

Sources

Based on Avital Wulz, Gabrielle Miller, Livia Navon and Jill Daugherty, "Emergency Department Visits by Incarcerated Adults for Nonfatal Injuries — United States, 2010–2019," MMWR Morbidity and Mortality Weekly Report, volume 72, Centers for Disease Control and Prevention; a work of the United States government in the public domain. The report's discussion rounds the incarcerated visits to "an estimated 750,000"; this page uses its results' 733,547.